Missing referrals and authorizations – a hidden reason for denials

DATE

CLIENT

CATEGORY

Missing referrals and authorizations - a hidden reason for denials

ABOUT

The client is a dermatology group based in Illinois.

CHALLENGES

1) Ongoing denials due to authorizations and referrals. The client faced continued denials because they lacked a process to collect authorizations and referrals in time. This created a significant bottleneck towards payments after claims were submitted and insurances demanded authorization numbers and referrals.
2) Huge A/R backlog. Inflated AR due to lack of medical record information. $160,000 was stuck in old Accounts Receivable because suitable information was not provided to insurances in time.

WHAT WE DID

After we started, it took several weeks to coordinate and tune processes on the client’s end. We even faced challenges of scheduling a weekly call to square away denials. However, through persistence we streamlined the group’s billing process by doing the following:

1) We took ownership of obtaining authorizations and referrals 2-days prior to the date of service. This process immediately closed the leaky tap on denials and resulted in an upswing in collections.
2) We increased the number of calls that went out to insurance companies to follow up on old claims. This effort resulted in closing the loop on old, inflated AR.

LIFE WITH NEXTSERVICES

Dermatology practices greatly depend on patient satisfaction. When claims are denied because of a lack of billing process, it not only adds financial pressure to the practice but also results in their patient customers receiving avoidable bills (that should’ve been originally paid by insurances).

We fully realize that billing is not a one time streamlining activity and can slip anytime when it doesn’t get due attention. Our team works to ensure that the client wins every week.